Woolrich A J, DaSilva M D, Korelitz B I
Department of Medicine, Lenox Hill Hospital, New York, New York.
Gastroenterology. 1992 Aug;103(2):431-8. doi: 10.1016/0016-5085(92)90831-i.
Biopsies obtained at colonoscopy from 121 patients with ulcerative colitis (UC) for greater than 7 years were reviewed. Dysplasia or neoplasia was found in 27 patients (22%) after a mean of 16 years; 22 (18%) had dysplasia (all low grade), 2 had polyps, and 3 had carcinoma without prior dysplasia. Seven had dysplasia (or neoplasia) on the next examination, and another 4 after multiple negative examinations. Dysplasia preceded carcinoma in 4 (18%) of the 22 patients, and carcinoma occurred in 7 (6%) of 121 patients. The average time from the first encounter of dysplasia to the finding of carcinoma was 6.3 years, and 3 of 4 patients with negative second colonoscopies then had unremarkable examinations for 2-5 years. Dysplasia without cancer was found later in another 3. Dysplasia was found in 12 of 13 colectomy specimens, including the 3 from patients with cancer in whom no dysplasia had been found at surveillance colonoscopy. Active disease did not eliminate the capability to detect dysplasia or negate the value of surveillance for cancer when colonoscopy was conducted for routine clinical indications. Most dysplasia was detected in the rectum and sigmoid, supporting the value of interim sigmoidoscopies and biopsies during routine management of UC. Compliance for surveillance was diminished when the patient was asymptomatic, thereby increasing the risk of cancer. Low-grade dysplasia, like high-grade dysplasia, is predictive of future carcinoma and warrants careful follow-up. A "negative" second examination is no basis for a sense of security or relaxation of vigilance.
对121例患溃疡性结肠炎（UC）超过7年的患者在结肠镜检查时获取的活检标本进行了回顾。平均16年后，27例患者（22%）发现发育异常或肿瘤形成；22例（18%）有发育异常（均为低级别），2例有息肉，3例有未发生过发育异常的癌。7例在下次检查时发现发育异常（或肿瘤形成），另外4例在多次阴性检查后发现。22例患者中有4例（18%）发育异常先于癌出现，121例患者中有7例（6%）发生癌。从首次发现发育异常到发现癌的平均时间为6.3年，4例第二次结肠镜检查为阴性的患者中有3例随后2至5年检查无异常。另外3例后来发现无癌的发育异常。13例结肠切除标本中有12例发现发育异常，包括3例在监测结肠镜检查时未发现发育异常的癌症患者。当为常规临床指征进行结肠镜检查时，活动性疾病并未消除检测发育异常的能力或否定癌症监测的价值。大多数发育异常在直肠和乙状结肠被检测到，这支持了在UC常规管理期间进行乙状结肠镜检查和活检的价值。当患者无症状时，监测的依从性降低，从而增加了癌症风险。低级别发育异常与高级别发育异常一样，可预测未来的癌，需要仔细随访。第二次检查“阴性”并非放松警惕或感到安全的依据。
